DANYELLE MATTHEWS
San Francisco Bay Area,California
Summary
Results-driven Market Access and Patient Access professional with over 10 years of experience in complex reimbursement environments and specialty therapy access. Expertise includes field reimbursement, patient navigation, benefit investigations, prior authorizations, and payer policy. Effectively collaborates with healthcare providers and market access teams to eliminate access barriers and enhance patient experiences.
Overview
11
11
years of professional experience
Work History
Field Reimbursement Manager
Eversana
San Francisco Bay Area, CA
03.2026 - 07.2026
- Collaborated with hub services, market access, and field sales teams to provide market insights and enhance patient access strategies. Informed healthcare providers, hospital administrators, and clinic staff on payer policies, coding requirements, and reimbursement processes to facilitate patient access. Resolved complex patient specific coverage barriers to minimize delays in access to specialty pharmaceutical therapies. Utilized electronic benefit verification and prior authorization tools to streamline reimbursement workflow. Managed high-volume field operations and territory activity while aligning strategies with cross-functional stakeholders.
- Managed reimbursement support workflows for EVERSANA patient access services.
- Guided staff through payer benefit investigations and coverage reviews.
- Reviewed prior authorization requests for accuracy and completeness.
Senior Patient Navigator
Mercalis
08.2025 - 02.2026
- Managed end to end patient access and reimbursement cases, serving as a strategic resource for patients, HCPs, and field stakeholders. Drove resolution of complex access barriers through high benefit investigations, prior authorizations, appeals, payer navigation, and coverage optimization. Educated HCPs and patients on payer requirements, reimbursement pathways, and patient support programs. Partnered cross-functionally with field teams and client stakeholders to resolve complex reimbursement challenges and support patients in meeting commercial and government payer requirements, including Medicare/Medicaid, ICD-10, CPT, and HCPCS. Maintained compliant case documentation and escalated adverse events, product complaints, and special situations in accordance with program requirements.
Field Reimbursement Manager
ReMx
02.2025 - 08.2025
- Navigated complex specialty drug reimbursement pathways, resolving benefit investigations, Prior authorizations, appeals, and claim denials. Advised provider offices on payer policies, coding standards, submission requirements, and reimbursement processes. Managed a high-volume field team, conducting field visits 4-5 days per week across hospitals, clinics, and provider offices. Coordinated copay and patient assistance resources to address financial barriers and support treatment access. Served as a respected subject matter expert on Medicare Part D, Medicaid, and commercial payer requirements.
Case Access Manager Neuromuscular
United Biosource Corporation UBC
07.2024 - 01.2025
- Managed patient access caseloads and served as the primary resource for prior authorization, appeals, benefits, and therapy initiation. Coordinated with providers and stakeholders to communicate patient needs, responsibilities, and available access resources. Conducted quality reviews and resolved complex cases while maintaining regulatory and program compliance. Identified and reported adverse events and product quality issues in accordance with pharmaceutical requirements.
Access & Reimbursement Manager - Immunology
Synos Health
04.2022 - 07.2024
- Advised healthcare organizations on payer access and reimbursement strategies to optimize patient access to specialty therapies. Educated HCPs on product fulfillment pathways, including buy-and-bill, retail pharmacy, and specialty pharmacy models. Supported access strategies across neurology, dermatology, and rheumatology disease states. Delivered provider education on medical billing, coding, reimbursement trends, and practice administration. Partnered with reimbursement teams and third-party support programs on copay assistance, prior authorizations, claims denials, benefit verification, and clinical policy education.
Neuroimmunology Patient Navigator
Genentech
San Francisco Bay Area, CA
01.2018 - 04.2022
- Resolved reimbursement and payer access barriers to support timely access to neurology therapies. Partnered with internal teams to address payer issues and communicate coverage criteria to patients and providers. Assisted patients with benefits education, appeals, and insurance-related challenges. Supported implementation of patient access and care models designed to improve the patient and provider experience. Led and motivated a team of five Patient Navigators, exceeding organizational goals for outreach and care coordination.
Patient Access Representative
Covance
San Diego, California
11.2015 - 01.2018
- Managed end-to-end insurance verification and benefit investigations for medical and pharmacy benefits, successfully determining eligibility and identifying optimal financial pathways for patients.
Coordinated and submitted prior authorization requests, proactively troubleshooting insurance claim rejections and resolving complex appeals to ensure zero interruptions in critical therapy.
Enrolled patients into manufacturer co-pay cards, patient assistance programs (PAP), and foundation grants, significantly reducing out-of-pocket costs and increasing medication compliance.
Maintained streamlined, empathetic communication channels between healthcare providers, insurance payers, and specialty pharmacies to expedite the medication distribution process.
Maintained strict HIPAA compliance while accurately documenting casework, tracking claims statuses, and managing patient data within electronic health records (EHR) and CRM systems.
Education
Master of Public Health -
Johns Hopkins Bloomberg School of Public Health
12-2022
Master of Science Global Leadership -
University of San Diego
12-2018
Bachelor of Business Administration - Marketing & Sociology
University of Wisconsin
12-2014
Skills
- Market Access & Reimbursement
- Patient Access & Navigation
- PA/Appeals Support
- Claims Management
- Billing & Coding (ICD-10 , HCPCS, CPT)
- Payer & Policy Cover
- Specialty Pharmacy
- Buy-and-Bill
- Cross-Functional Collaboration
- Provider & HCP Education
- Territory Optimization
- CRM Reporting & Territory Analytics
LANGUAGES
English | native
Timeline
Field Reimbursement Manager
Eversana
03.2026 - 07.2026
Senior Patient Navigator
Mercalis
08.2025 - 02.2026
Field Reimbursement Manager
ReMx
02.2025 - 08.2025
Case Access Manager Neuromuscular
United Biosource Corporation UBC
07.2024 - 01.2025
Access & Reimbursement Manager - Immunology
Synos Health
04.2022 - 07.2024
Neuroimmunology Patient Navigator
Genentech
01.2018 - 04.2022
Patient Access Representative
Covance
11.2015 - 01.2018
Master of Public Health -
Johns Hopkins Bloomberg School of Public Health
Master of Science Global Leadership -
University of San Diego
Bachelor of Business Administration - Marketing & Sociology
University of Wisconsin